This patient was operated twice
with a relapse of her incontinence and with a clinic history associated with the physical
exam and the auxiliary exams already described, we made a diagnosis of recurrent stress
urinary incontinence. We must keep in account, besides this that she presents predisposing
factors as obesity, postmenopause, multiple deliveries, the probable weakness of the
mesenchyme (chronic venous insufficiency) and the aforementioned surgical interventions.
With such a diagnosis the medical staff decides to put an intraurethral valvular
prosthesis 5,6 (figure 1). This
prosthesis is indicated for the cases of urinary incontinence by sphincter deficiency; the
urinary incontinence that did not respond to surgical treatment or in those patients in
which surgery in not indicated, but without bladder instability.
Such prosthesis consists of a valve with a siliconed coating sheath made in different
sizes, with a small pump with a magnet in its interior operated by a small remote control
that works with a battery. The technical setting is easy, being done in the ambulatory, by
trained personnel (figure
2). Previous antiseptic of the meatus the length measurement of the urethra is taken
with a milimetered Foley catheter. With the measurement taken the proper sheath is chosen.
Previous to the lubrification, such sheath is inserted in the urethra, till it reaches the
proximal portion of the urethra, the plunger is pushed until the sheath is completely
separated and the plunger is discarded. Using the remote control, the valve is checked.
Once the valve is in place, each time the patient feels like urinating the remote control
must be placed at the height of the pubic region, pressing the activator (fig. 3A/B), which sets the pump to
work permiting the patient to urinate. When this is completed, the patient stops pressing
the activator and will be continent.
The results of this studies 5,6
show a rate of success of 80% to 95% compared to other surgical treatments. The women who
have been treated have been able to have a full and normal life.